Teratoma Lung Mediastinum

Surgery of metastatic disease after chemotherapy is indicated for the majority of patients with a residual mass; normal STMs are mandatory only following first-line chemotherapy whereas every mass should be resected in the salvage setting every time it is technically feasible. Only patients with no evidence of a residual postchemotherapy mass and with normal or normalized markers do not need postchemo-

Tumor Vagus Vein

Figure 11-19. A, Computed tomography scan showing a right para-tracheal residual tumor (desperation surgery following surgery following third line chemotherapy). B, The mass adherent to the superior vena cava, the trachea, and the origin of the right bronchus encircling the azygos vein; the phrenic and vagus nerves have been isolated. C, The operative field after removal of the mass. D, The resected mass, with the sulcus of the azygos vein.

Figure 11-19. A, Computed tomography scan showing a right para-tracheal residual tumor (desperation surgery following surgery following third line chemotherapy). B, The mass adherent to the superior vena cava, the trachea, and the origin of the right bronchus encircling the azygos vein; the phrenic and vagus nerves have been isolated. C, The operative field after removal of the mass. D, The resected mass, with the sulcus of the azygos vein.

Recovery After Fibroid Tumor SurgerySerratus Muscle Tumor

Figure 11-21. A, Computed tomography scan showing several lung metastases on the right side only. B, Vertical skin incision along the midaxillary line and skin dissection anteriorly to the pectoralis major and posteriorly to the dorsal vessels and nerve. C, Following separation of the serratus anterior, the intercostal muscles are divided in the sixth intercostal space. D, Stapler resection of lung metastases.

Figure 11-21. A, Computed tomography scan showing several lung metastases on the right side only. B, Vertical skin incision along the midaxillary line and skin dissection anteriorly to the pectoralis major and posteriorly to the dorsal vessels and nerve. C, Following separation of the serratus anterior, the intercostal muscles are divided in the sixth intercostal space. D, Stapler resection of lung metastases.

Intercostal Muscle

Figure 11-22. A, Computed tomography scan showing a small right retrocrural residual teratoma. B, After opening the epiploon retrocavity between the liver and the stomach, the right diaphragmatic crus is opened vertically, and the right para-aortic tissue is dissected from the aorta (left). C, The resected small right retrocrural teratoma (the operation is easier on the left side).

Figure 11-22. A, Computed tomography scan showing a small right retrocrural residual teratoma. B, After opening the epiploon retrocavity between the liver and the stomach, the right diaphragmatic crus is opened vertically, and the right para-aortic tissue is dissected from the aorta (left). C, The resected small right retrocrural teratoma (the operation is easier on the left side).

Mass Between Lung And Diaphragm

Figure 11-23. A, Computed tomography showing a huge right retroperitoneal teratomatous mass. B, Multiple bilateral hilar and mediastinal masses. C, Right laparo-phreno-thoracotomy interrupting the costal arcade. From right to left can be seen the omentum covering the intestine and the mass, the liver, and the opened diaphragm. The lung cannot be seen. D, The resected retroperitoneal mass, with the spermatic vessel, a lung metastasis, and posterior mediastinal, subcarenal, and parahilar cystic masses of the right side.

Figure 11-23. A, Computed tomography showing a huge right retroperitoneal teratomatous mass. B, Multiple bilateral hilar and mediastinal masses. C, Right laparo-phreno-thoracotomy interrupting the costal arcade. From right to left can be seen the omentum covering the intestine and the mass, the liver, and the opened diaphragm. The lung cannot be seen. D, The resected retroperitoneal mass, with the spermatic vessel, a lung metastasis, and posterior mediastinal, subcarenal, and parahilar cystic masses of the right side.

Posterior MediastinumParaaortic Nodes

Figure 11-25. Artistic representation of the para-aortic nodes, cisterna chyli, great and renal vessels, and diaphragmatic crura; the right para-aortic nodes encircle the inferior vena cava, and the left para-aortic nodes are on the left side of the aorta. Retroperitoneal lymphatic drainage goes up into the thorax, passing behind the renal vessels and beneath the diaphragmatic crura.

Figure 11-25. Artistic representation of the para-aortic nodes, cisterna chyli, great and renal vessels, and diaphragmatic crura; the right para-aortic nodes encircle the inferior vena cava, and the left para-aortic nodes are on the left side of the aorta. Retroperitoneal lymphatic drainage goes up into the thorax, passing behind the renal vessels and beneath the diaphragmatic crura.

therapy surgery; patients with low-risk parameters (very small residual mass with > 90% shrinkage, no teratoma in the primary tumor, normal postchemo-therapy marker levels) can undergo an expectant policy only if a very careful follow-up can be guaranteed. Fibrosis and/or necrosis can be predicted

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